In a recent report published by The Commonwealth Fund, the United States health care system ranked 11th behind ten other industrialized nations. In first place was the United Kingdom, followed by Switzerland and Sweden.

The rankings were determined by a recent international study that evaluated the quality, access, efficiency and equity of each country’s health care system. Researchers also measured a number of health indicators, such as infant mortality. And despite the United States having the highest health expenditures, it ranked last in access, efficiency and equity.

The report notes that the data was collected a year before the Affordable Care Act was fully implemented, and therefore excludes any effects the law has thus far had on the expansion of access to care and the improvement of equity between those with varied incomes.

Karen Davis, author and professor at the Johns Hopkins Bloomberg School of Public Health, is optimistic that the enactment of Obamacare has brought the United States into “a new era in American healthcare,” as reported by the LA Times.

And in good news, the United States ranked 3rd in effective care and 4th in patient-centered care.